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Adrenalectomy in Older Americans has Increased Morbidity and Mortality: An Analysis of 6,416 Patients

  • Healthcare Policy and Outcomes
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Abstract

Background

The incidence of adrenal tumors increases with age. We examined the impact of older age (>60 years) on clinical and economic outcomes after adrenalectomy.

Methods

Adult patients who underwent adrenalectomy in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003–2008 were categorized into age groups: ≤60 years, 61–70 years, and >70 years. Outcomes were compared using χ2 and ANOVA; multivariate regression was used to assess the independent effect of older age on adrenalectomy outcomes.

Results

There were 6,416 patients: 21.9% were 61–70 years, and 12.9% were >70 years. Compared with patients ≤60 years, patients 61–70 and >70 years had more complications (14.1% vs. 19.9 and 22.6%; p < 0.001) and mortality (0.4% vs. 1.3 and 2.3%; p < 0.001), longer mean length of stay (LOS) (3.3 vs. 4.0 and 4.9 days; p < 0.001), and higher mean costs ($12,307 vs. $13,226 and $14,649; p < 0.001). After adjustment, older age remained independently associated with sustaining one or more complications after adrenalectomy (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.1–1.7, for patients 61–70 years; OR 1.7, 95% CI 1.3–2.2 for patients >70 years) and longer adjusted LOS (1-day difference, p < 0.01). Age >70 years was independently associated with increased mortality after adrenalectomy (OR 2.8; 95% CI 1.4–5.6). Complications, LOS, and costs were reduced if patients underwent surgery by high-volume compared with low-volume surgeons.

Conclusions

Older age seems to be independently associated with adverse short-term clinical and economic outcomes after adrenalectomy. Enhanced access to high-volume surgeons is a potentially modifiable factor of particular importance in these patients.

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Acknowledgment

This study was supported in part by the Yale Medical Student Research Fellowship (Hadiza S. Kazaure).

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar St, Tompkins 208, New Haven, CT, USA

    Hadiza S. Kazaure BSc, Sanziana A. Roman MD & Julie A. Sosa MA, MD

Authors
  1. Hadiza S. Kazaure BSc
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  2. Sanziana A. Roman MD
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  3. Julie A. Sosa MA, MD
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Correspondence to Sanziana A. Roman MD.

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Kazaure, H.S., Roman, S.A. & Sosa, J.A. Adrenalectomy in Older Americans has Increased Morbidity and Mortality: An Analysis of 6,416 Patients. Ann Surg Oncol 18, 2714–2721 (2011). https://doi.org/10.1245/s10434-011-1757-5

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  • DOI: https://doi.org/10.1245/s10434-011-1757-5

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